From the Guidelines
Management of a gastrocnemius tear should prioritize conservative treatment, focusing on pain control, physical therapy, and gradual return to activities, as surgery is rarely needed except for complete tears or when conservative treatment fails. The most recent and highest quality study 1 provides guidance on the management of osteoarthritis, which can be applied to the management of a gastrocnemius tear.
Key Components of Management
- Pain control can be achieved with over-the-counter medications like acetaminophen or NSAIDs such as ibuprofen for 5-7 days 1.
- Physical therapy should begin after the acute phase, typically within 1-2 weeks, focusing on gentle stretching, progressive strengthening exercises, and proprioception training 1.
- Severe tears may require a walking boot or crutches for 1-2 weeks.
- Gradual return to activities is essential, with running and jumping sports typically resumed after 6-8 weeks when full strength and range of motion are restored.
Conservative Treatment
Conservative treatment is the preferred approach for managing gastrocnemius tears, as it allows the torn muscle fibers to heal while preventing muscle atrophy and maintaining overall function. The study by 1 highlights the importance of conservative treatment in managing osteoarthritis, which can be applied to the management of a gastrocnemius tear.
Surgery
Surgery is rarely needed except for complete tears or when conservative treatment fails. The study by 1 notes that surgery should be considered for refractory pain associated with disability and radiological deterioration, but this is typically not the case for gastrocnemius tears.
Return to Activities
Gradual return to activities is essential to prevent re-injury and promote full recovery. The study by 1 highlights the importance of supervised exercises in preventing ankle sprains, which can be applied to the management of a gastrocnemius tear. Running and jumping sports can typically be resumed after 6-8 weeks when full strength and range of motion are restored.
From the Research
Management of Gastrocnemius Tear
The management of a gastrocnemius tear can be approached through various methods, including non-operative and operative treatments.
- Non-operative treatment is often the first line of approach, which may include the PRICE principles (protection, rest, ice, compression, and elevation) for symptomatic relief, followed by stretching, strengthening, proprioception, and conditioning exercises 2.
- The use of platelet-rich plasma (PRP) injections has also been studied as a potential treatment for gastrocnemius strains, with results showing a significant reduction in time to functional recovery and return to sport activity compared to standard therapeutic approaches 3.
- Surgical treatment is rarely indicated, but may be considered in cases of tendinous injury or avulsion, particularly in patients who require forceful plantar flexion for their desired activities or occupation 4, 5.
- Postoperative bracing and a graduated therapy progression, including range of motion, strengthening, and return to activities, are important components of surgical treatment 5.
- In some cases, forced-use therapy during neurologic rehabilitation may be a potential cause of gastrocnemius tears, and should be approached with caution to avoid overstretching and muscle injury 6.
Treatment Options
- Non-operative treatment:
- PRICE principles
- Stretching and strengthening exercises
- Proprioception and conditioning exercises
- Operative treatment:
- Surgical repair of tendinous injury or avulsion
- Postoperative bracing and graduated therapy progression
- Alternative treatments:
- Platelet-rich plasma (PRP) injections
- Forced-use therapy (with caution)